Medicine Through Time

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Prehistoric

Medicine:

What did they die

from?;

-Infection.

-Warfare.

-Famine and food

shortages.

-Pregnancy +

childbirth.

Beliefs and

Treatments;

-Supernatural

Evil

spirits, witches, spirits of the dead etc. caused disease.

Medicine Men

dealt with evil spirits causing disease by praying and using charms.

Lucky charms

kept away evil spirits.

-Natural

Covered

broken bones in mud and leaves, like a cast.

Herbs and

honey for sore throats.

Women were

in charge of everyday health + knew about healing power of herbs.

For everyday injuries they had range of simple effective remedies,

passed down through generations.

Trephining

(cutting holes in people's heads) to release evil spirits. Skulls

found show that people survived the operation as the bone continued

to grow afterwards.

-The people were

hunter gatherers (living nomadic lives) until 10,000 BC and farmers

afterwards.

How do we know

about it?;

-Skeletal

remains.

-Aboriginal

cultures still live as they did in prehistoric times.

Egyptians:

Supernatural

beliefs and treatments;

-Gods could cause

and cause disease. Priests recorded treatments and spells.

-Some drugs (e.g.

opium) are used today. They were probably thought of as driving away

evil.

-Mummification~

Body was needed in the afterlife, so they were preserved through

mummification.

-Experimental

dissection not allowed as believed that destroying someone's body

meant they wouldn't go to the afterlife. This limited the amount of

knowledge gained (knew about the main organs but not about their

purpose).

Natural Beliefs

and treatments;

-Diet was

important. Doctors recommended certain foods to patients.

-Like the Nile,

the body was full of channels. Sickness was caused by the blockage of

one of your body's channels. Purging, vomiting and blood-letting was

used to unblock the channels.

-Hygiene~

cleanliness was valued. They bathed, shaved their heads, had toilets,

changed clothes etc.

-Trained

specialist doctors observed their patient's and recognised the

symptoms. Wrote down symptoms and treatments.

-Society~

agricultural civilisation around River Nile. Every year the Nile

floods fertilised the fields and the river provided water for

irrigation.

Ancient Greek:

-Background~ used

slaves so had time to educate themselves, war wounds needed

treatments and helped doctors learn about anatomy, wealthy people

employed doctors.

Surgery;

-Advanced

slightly, but still risky (a last resort).

-Good techniques

for setting broken bones and amputations.

-Range of

surgical instruments from iron, steel and brass.

Dissection;

-Erasistratus

identified differences between arteries, veins and nerves.

-The library of

Alexandria attempted to collect all the knowledge of the world.

Unlike the rest of Greece, human dissection was allowed. Alexandria

became famous for training medics and surgeons.

Natural beliefs

and treatments;

-Healthy living

Exercised.

Hygiene was

important.

Healthy

diet~ many followed a diet that changed with the seasons~ eating

lots in winter drinking little, and in summer drinking more + eating

less.

-Hippocrates

Hippocratic

Corpus~ a collection of medical books written by Hippocrates

containing symptoms and treatments.

Observing

and recording – 'clinical method of observation' and recorded

observations to help future diagnosis.

Hippocratic

Oath~ promised made by doctors to obey rules of behaviour in

professional lives. Still happens today!

Believed in

natural causes of disease and encouraged natural treatments.

Theory of 4

Humours~

The body is

made up of 4 humours which are like dot the 4 seasons and the 4

elements. They need to be in balance for good health. If you are

sick, it is because your humours are unbalanced.

Treatments

aimed at bringing humours back into balance

vomiting

purging

blood-letting

Spring~Blood

Winter~Phlegm

Summer~Yellow

bile

Autumn~Black

bile

Ancient Rome:

-Background~

Romans were very wealthy. People of Roman Empire were taxed. Slave

owning society.

Beliefs and

treatments;

-Doctors too

expensive for most. Head of family expected to look after household

(using herbal remedies).

-Not as

interested as Greeks in developing theories on causes of disease.

-Doctors

recommended exercise, diet change + prescribed herbal medicines as

opposites.

Surgery;

-Common surgery

was bleeding, amputations + trephining.

-Internal

operations rare (as still risky).

Public Health;

-Bad smells,

unclean drinking water, sewage, swamps and dirt made people sick.

-Aqueducts

carried clean water into cities.

-Public baths,

toilets, sewers.

-Ideas of public

health spread through empire.

Galen;

-Developed on

Theory of 4 Humours with Theory of Opposites.

The

treatment had to be opposite to the cause.

-Brain, not

heart, controls speech.

-Arteries, as

well as veins, carry blood through body.

-Animal's anatomy

different from humans.

-BUT...

Made

mistakes as he only used animals.

Said holes

in septum of heart to let blood pass from right to left side.

Believed

blood was consumed not circulated.

Medieval:

Background;

-Wars destroyed

Roman public health system + medical libraries. Rulers of small

kingdoms built up armies rather than improving medical skills/public

health. War disrupted trade, so countries became poorer. Travel

become dangerous, reducing communication between doctors. Training of

doctors abandoned, Galen's books lost/ hidden for safety.

-LATER... church

set up universities where doctors were trained. Armies took trained

doctors to war where they gained experience as surgeons. Rulers

cleaned up towns. Merchants and scholars travelled around Europe,

sharing ideas.

Public health;

-Cesspit’s,

wells, waste disposed of in streets, drank beer not water etc.

Influence of

Christian Church;

-Church grew

stronger. Monasteries controlled education, priests and monks only

people who could read. Church opened medical schools where Galen's

ideas were taught. Only libraries were in monasteries, churched

manned book they disapproved of. Monasteries provided clean water and

toilets.

New Developments;

-Surgery

Warfare

caused a big demand for surgery. Wine used as antiseptic, surgical

treatments were simple and major surgery risky.

-New techniques~

diagnosis by urine sample.

-Stars caused

disease~ used astrology to decide treatments.

-More schools,

human dissection allowed. Doubts about classical texts.

-Trained doctors

expensive, most treated by monks and housewife-physicians.

Hospitals;

-Genuinely ill

turned away~ fear of spreading disease.

-Medical care for

poor~ hospitals sets up by monasteries, provided 'hospitality for

visitors.'

Return of

Hippocrates and Galen;

-Galen's ideas

rediscovered. Church look at Galen's works and decided what fitted

with Christian ideas (e.g of a 'Creator'). Doctors believed he was

correct and was impossible to improve his work.

-Medical schools

in Western Europe where translations of Galen's and Hippocrates' work

accepted as absolute truth.

-4 Humours~ still

believed by doctors. Theory developed into more complex system using

position of stars. Human dissection carried out in medical schools,

findings were interpreted as theory of 4 humours~ but later doctors

challenged traditional theories.

Arab medicine;

-Books brought

together ideas of Galen and Hippocrates.

-Attitude of

Muslims towards Koran meant they were unwilling to criticise Galen.

-Islamic

scholars picked up and developed Greek ideas. 4 Humours, treatment of

opposites and clinical observation lived on.

Black

Death – 1348;

-Arrived

in Britain in 1348.

-Spread

by coughs sneezes, black rat flea bites (rates carried overseas by

ships).

-Causes

and treatments.

Poisoned

water~ blamed Jews

God

- prayed, flagellants.

4

Humours~ opposites, purging, vomiting, blood letting.

-Symptoms

Breathing

difficulties.

High

temperature.

Swellings.

Exhaustion.

Renaissance:

Background;

-Began

with lose study of classic texts + being critical of old

translations.

-Return

of classical texts renewed faith in 4 Humours + Opposites theory.

-'Rebirth'.

-Greater

interest on how human body worked (observation + dissection)

Public

health;

-Many

wars which took up resources.

-Increasing

urban population~ strain on clean water supplies + sewage systems.

Factors;

-Printing

Press~ ideas spread

-Weakening

power of Church~ no religious beliefs on causes of disease~ looked

for natural causes + could dissect.

-Artists

drawing from life~ medical drawings drawn + shared.

-Renewed

interest in Ancient learning~ people wanted to learn how to read,

challenged old medical ideas.

Vesalius

– Anatomy;

-Studied

anatomy, became professor of surgery and anatomy. Did dissections +

wrote books based on his observations using accurate diagrams. 1543~

wrote 'On The Fabric of the Human Body.'

-Pointed

out Galen's mistakes by proving...

Jaw

bone one bone, not two.

No

holes in septum of heart.

Paré~

Surgery;

-Disproves

Galen by proving the bezoar stone isn't a treatment for poison.

-Battlefield

surgeon, in battle he ran out of boiling oil (used to treat gunshot

wounds) so made an ointment of roses, turpentine + egg yolk.

-Develops

ligatures to seal wounds.

Harvey~

circulation of blood;

-Identifies

difference between arteries + veins.

-Disproves

Galen by discovering circulation of blood.

Black

Death 1665;

-Worst

appearance. Death toll = 100 000.

-To

control spread households locked in + red crosses painted on doors.

-Carts

organised by police roamed city collecting corpses for mass burial.

-People

realised disease was contagious, but not that germs caused it.

1750- 1900:

Smallpox

+ Edward Jenner;

-Inoculation

In

18c, small pox was a big killer. People immunised against smallpox

using pus from sores of a sufferer. But sometimes led to death.

-Edward

Jenner

Country

doctors, heard that milkmaids didn't get smallpox, instead milder

cowpox. Discovered that people who had cowpox didn't get small pox.

1796 - inoculated small boy with pus from sores of cowpox sufferer.

Then injected James with smallpox, James didn't catch the disease!

-Opposition

to smallpox vaccine.

Jenner

couldn’t scientifically explain who it worked. Inoculators afraid

of losing money. Worried about side effects (e.g cowpox). Church

believed vaccination wasn't natural.

Why

did they stop reading Galen in the 19th

century?;

-New

understanding of body and Galen's descriptions were incomplete/wrong.

-Doctors

did dissections + used microscopes. Galen's books not important.

-4

Humours not accepted. People initially thought miasma caused disease.

Developments

in nursing;

-Mary

Seacole~ poor Jamaican background. Volunteers to be nurse in Crimean

war, is rejected but does anyway self-financing journey. Nursed

soldiers on battlefields and built 'British Hotel.' Goes bankrupt

when returns to UK~ receives support due to press interest in story +

write autobiography.

-Florence

Nightingale~ Brought discipline + professionalism to a job with bad

reputation. Wealthy background, became nurse despite family opposing.

Went to Crimean War to sort out nursing care in English camp.

Improved death rates, due to improvements in ward hygiene. Returned

home + wrote book 'Notes on Nursing' + sets up hospital in London.

How

did scientists discover the causes of disease?;

-Robert

Koch~

German scientist. Linked diseases to the specific microbe. Developed

dying techniques to colour microbes, which he viewed through

microscopes. Identified anthrax spores and bacteria causing

septicaemia, tuberculosis + cholera.

-Louis

Pasteur's Germ Theory (1857)~ Scientists thought microbes were caused

by disease + appeared because of illness (spontaneous generation).

Instead of blaming microbes, people looked for miasmas. Pasteur

proved that there are germs in the air by sterilising water and

keeping it in a flask that didn't allow airborne particles to enter.

This stayed sterile~ but sterilised water kept in an open flask bred

microbes.

-Pasteur~

Chicken Cholera Vaccine~ Hearing of Koch's work Pasteur decided to

find new microbes and combat them. Looked for cures to anthrax +

chicken cholera. Chamberland (worked for Pasteur) was supposed to

inject chickens with chicken cholera but forgot. Left germs and

injected them when he returned from holiday. Chickens survived, and

survived when new germs were injected. Cholera was weakened by being

left out and had made the chickens immune.

-Pasteur~

Anthrax vaccine~ Produced weakened version of anthrax spore that

would make sheep immune.

Overcoming

the problems of surgery;

-Surgery

in the 18000s was dangerous + painful.

Main

problems.

Pain~

die of shock.

How

was the problem of pain overcome?-

Opposition~

uncomfortable for patients, pain good of healing, didn't understand

how they worked or side effects, pain from God, encouraged riskier

operations.

Final

acceptance~ Queen Vic used chloroform in delivery of 8th child.

In

1800, surgeons would ease suffering of patients by getting the

drunk, knocking them out, opium etc.

Anaesthetics-

Nitrous

Oxide~ 'laughing gas' discovered by Sir Humphrey Davy.

Ether~

used by J.R. Listen during leg amputation. Unpleasant side effects.

Blood

loss.

How

was the problem of blood loss overcome?

Once

William Harvey discovered the circulation of blood, the first blood

transfusions were attempted.

Early

blood transfusions were often disastrous because....

Blood

groups were not discovered.

Couldn't

prevent blood clotting.

Infection.

Infection.

How

was the problem of infection overcome?-

Final

development of ASEPTIC surgery~ by late 1890s Listers methods led to

aseptic surgery (removal of all possible germs form theatres to

ensure absolute cleanliness).

All

surgical instruments steam sterilised.

Operating

theatres + hospitals rigorously cleaned.

Sterilised

rubber gloves first used and surgeon's hands scrubbed.

Joseph

Lister + the discovery of antiseptics~ He heard that carbolic spray

was used on sewage + knew sewage had similar smell to gangrene. Read

Pasteur's germ theory. Prepared to take risks.

Opposition-

Lister's

methods slowed down surgery.

Germ

theory not widely accepted in 1857.

Spray

was uncomfortable for doctors to use (affected skin).

Surgeons

didn't copy methods correctly so were disappointed with results.

Until

Germ Theory in 1850s, surgeons didn't take precautions to protect

open wounds (reused bandages, didn't wash hands, didn't sterilise

surgical equipment etc.)

Developments

in Public Health;

-Public

Health Problems in early 1800s~ conditions in British towns became

increasingly worse. Crowded towns + cities due to industrial

revolution. Towns couldn't cope with providing water + sewage to more

people. In squalid conditions, disease spread rapidly.

-Battle

to improve public health~ some thought government should force local

councils to clean up towns. But, many believed in 'laissez-faire'

attitude + that government should allow local areas to control its

own affairs.

-Edwin

Chadwick~ 1842~ asked by government to report on living conditions in

towns. Concluded that poverty was caused by ill health which was

caused by terrible living conditions. Said in 'Report on the Sanitary

Conditions of the Labouring Population' that towns should;

1)

organise drainage + refuse collection.

2)

provide water supply.

3)

appoint medical officer of health.

-1848

Public Health Act~ outbreak of cholera put pressure on government to

pass Public Health Act. Not compulsory. Government set up Board of

Health to encourage local authorities to improve conditions. Gave

them money to make improvements, but only a few local authorities

took new measures. 1854~ Board of Health abandoned.

-1853

John Snow ~ proved there was a link between cholera + water supply.

Used research, observation + door-to-door interviews to build a

detailed map of cholera epidemic in Broad Street. Nearly all deaths

had taken place within short distance from water pump. Near to pump,

there was a brewery and none of the people had cholera because the

brewery had its own water pump. So they didn't use the Broad Street

Pump. Snow removed the handle + there were no more deaths. Later came

to light that ta cesspit near the pump had cracked, leaking into the

water supply. Put pressure on water companies to clean up their water

supplies.

-1858

Great Stink~ The hot weather caused the human waste in the River

Thames to stink. Putrid smell right under Parliament's nose, they

considered moving and had to coat curtains with deodorant to get rid

of smell. Great Stink prompted Parliament to sort out London's sewage

+ drainage system + to clean up Thames.

-1867

Second Reform Act~ working class men given vote. MPs wanted to win

support of working class so improved living conditions of poor.

-1875

Second Public Health Act~ Forced local authorities to;

1)

provide clean water

2)

provide drainage + sewage

3)

appoint Medical Officer of Health. But why was it introduced?

-Results

of the Public Health Act of 1875~ improved standards of living,

stopped pollution of rivers form which people got water, shortened

working hours in factories for women + children, made it illegal to

add ingredients that made food unhealthy, made education compulsory.

20th Century:

Impact of WW2;

-Drugs~

penicillin developed as first antibiotic.

-Surgery~

development in use of skin grafts + treatment of burns.

-Poverty~

evacuation took children out of urban areas, highlighted contrast

between rich + poor.

-Blood

transfusion~ blood could be stored for longer, civilians donated

blood.

-Diet~ rationing

improved some people's diet, government encouraged healthy eating.

-Hygiene~

government posters educating people about health + hygiene.

What medical

progress did WW1 bring about?;

-Soldiers

promised good housing upon return. So got rid of unhealthy slum

housing.

-Surgeons

experimented with new techniques (developed new ways to repair broken

bones + perform skin grafts~ plastic surgery).

-Blood

transfusions~ in Renaissance, Harvey proved blood circulates,

encouraging transfusions, which sometimes worked + sometimes failed.

Blood groups were discovered in 1901 which made transfusions more

successful. During WW1 vast amounts of blood was needed. The search

of better method of storage + transfusion was needed. Doctors

discovered how blood can be bottled, packed in ice + stored where

needed.

-Development of

X-rays~ first discovered 20 years before WW1. Hospitals installed

X-ray machines, but WW1 confirmed their importance. More were

manufactured to meet demand, installed in hospitals along Western

Front. Immediately improved success rate of surgeons removing bullets

which could have caused fatal infections.

-Surgery of eye,

ear, nose + throat improve rapidly (includes brain surgery).

Penicillin;

-1) Fleming

discovered mould killed germs.Writes articles.

2) Florey + Chain

beginresearch after reading article by Fleming.

3) Penicillin

first tested on human in Oxford.

4) U.S. + Britain

fund production of penicillin.

5)Enough

penicillin produced to treat all allied forces wounded on D-Day.

-How was it

discovered?~ 1928, Fleming left a Petri dish of bacteria, it had gone

mouldy + the mould had killed the bacteria. Chance.

-Factors leading

to development;

Government~

UK Government funded Florey's research, U.S. Government funded mass

production.

War~ growing

casualties of WW2 added urgency to mass produce.

Individuals

+ Chance

Technology~

microscopes

-How was it

developed?

1930s,

Florey + Chain became interested in Fleming's paper. 1939, gathered

research team + asked UK Government to fund team's research into

penicillin. UK firms too busy with war effort to mass produce~ so

went to US. US Government helped by giving interest free loans. By

1944 mass production was sufficient for needs of military medics.

Fleming, Florey + Chain given Nobel Prize in 1945.

-National Health

Service;

Introduction

of NHS

Beveridge

Report in 1942 called for state provision of social security.

Aneurin Behave was Labour Minister for Health who introduced NHS.

National Insurance introduced to pay for NHS.

Influence of

WW2

Broke down

social distinctions. Raising armies made powerful people take notice

of health problems of poor. Evacuation of children increased

awareness of poor. After WW2 people wanted to improve society.

Stills has

few problems... The government reduced how much of NHS free (i.e.

charging for prescriptions). Long waiting lists + doubts of quality

of treatment mean some go outside NHS. Longer life expectancies mean

more care for elderly + increased costs for NHS.